深低温停循环围术期的高血糖监测及控制.ppt

ppt课件 深低温停循环围术期的高血糖监测及控制 Perioperative hyperglycemia monitoring and control during deep hypothermic circulatory * ppt课件 Abstract Objective Method Result Conclusion * ppt课件 Objective To observe the perioperative blood glucose trends during deep hypothermic circulatory arrest (DHCA), to evaluate the influencing factors of hyperglycemia and the clinical effects of insulin control * ppt课件 Method In department of cardiothoracic surgery of X hospital, 176 patients with aortic operation were performed under DHCA from 2000 to 2010. All patients’ blood glucose, arterial blood gas and lactate were tested at four time points of pre-CPB, pre-DHCA, post-DHCA and in-ICU. Hyperglycemia after surgery was controlled within 6~8 mmol/L by intermittent subcutaneous injection or intravenous micropump injection of insulin. At the same time, the amount of insulin within 24 h after surgery was calculated * ppt课件 Result The blood glucose (mmol/L) level of the time point of pre-DHCA was significantly higher than that of pre-CPB (9.62±1.79 vs 5.04±1.401, P0.05), the blood glucose level was further increased at the time point of post-DHCA (14.91±2.36) and in-ICU (15.32±2.47) than that of pre-CPB (P0.01). And the blood glucose elevated level was positively correlated with blood lactate level. 134 patients (76.1%) changed to use intravenous micropump injection of insulin due to poor effectiveness of intermittent subcutaneous injection of insulin to control blood glucose. Of whom 30 patients (17.0%) using continuous intravenous insulin still couldn’t control blood glucose effectively, which was the phenomenon of insulin resistance. Perioperative hyperglycemia during DHCA was associated with eld (≥ 50 y), hypertension, diabetes, serious aortic valve disease or coronary heart disease, emergency operation, CPB time, ≥ 3 h and DHCA time≥ 45 min (P0.05). The amount of insulin within 24 h after surgery was statistically significant (P0.05). * ppt课件 Conclusion DHCA can cause periopera